1. EXCITED DELIRIUMEmergency Services Implementing a unified plan with LEO and EMS
2. Excited DeliriumThe basics Autopsies reveal elevated levels of dopamine. Cocaine blocks re-uptake of dopamine resulting in elevated levels. Many ED patients have psych history as well. The combination basically leads to a runaway train effect where the bodys metabolism increases to the point acidosis and other imbalances cause respiratory and cardiac arrest.http://www.jems.com/article/patient-care/excited-delirium-strikes-witho
3. Agitation & ExertionAcidosis &Rhabdomyolysis Hyperthermia TREAT THE TRIAD
4. The presentation Psychotic behavior Aggressive behavior Hyperthermia Sweating Screaming or Roaring Remember mnemonic NOT A CRIME
5. N-O-T- A- C-R-I-M-E Naked = stripping off clothing and sweating profusely Objects = recall violence against objects, especially glass, shiny objects Tough = the person is very strong, unstoppable, seemingly endless endurance, and a diminished pain or insensitivity to pain Acute onset = You are told the person just snapped Confused = The person is unsure who (s)he is, where (s)he is located, why (s)he is there, and lacks perception Resistant = The person cannot or refuses to follow commands to stop his or her behavior. Incoherent speech = The person is shouting; bizarre content Mental health issues or Makes you feel uncomfortable Early EMS request, back-up request, and supervisor request.
6. Initial Contact Dispatch info Scene size up Immediate actions required Resources quickly available Maintain your safety Maintain surrounding public safety Maintain subject safety Plan of action
7. Initial Contact Do you have to act immediately? Can there be any other causes for the behavior? 1. Blood Glucose abnormality 2. Simple Psychosis 3. Simple Drug use 4. Alcohol 5. Trauma 6. Other?
8. Action Verbal--Talk them down (will not work with ED) Try talking to the person and see if you think there is any possibility of gaining compliance. Talk to bystanders; friends, family, co-workers. Determine if there is any possibility they can help gain compliance. Dont hesitate to move to restraint and sedation if escalating or not responding.
9. Action About to break Probably not going to remember knuckles anything. Will wake up in jail or ER. Should have syringe! Protecting firearm!
10. Action Physical-- Restraint Ideally 5 People Position of disadvantage One person for each extremity Paramedic to administer sedative Restrain SUPINE on Scoop Stretcher
11. Action www.exciteddelirium.org =
12. Media Story on ED
13. Action Chemical Restraint Administer chemical restraints as soon as possible
14. Death from ED Move to a safe position as soon as possible!
15. Action Drugs commonly used Drugs used here Side effects Place on Cardiac monitor and Capnography ASAP Watch for rhythm disturbances Consider Sodium BiCarb
16. Action Assessment Look for signs of trauma or other causes for Pt behavior Reassess and CLOSELY MONITOR Document Q 5min vital signs Notice hand placement. This works well for muscle isolation but if you place a spit hood on them that right hand can pull it off Consider using the bilateral chest straps (5point type) to keep the upper body on the cot and the spit hood on!
17. Action Transport to appropriate facility Continue reassessment and monitoring Notify receiving facility of pt condition and your differential diagnosis
18. Documentation Get witness statements if possible (LEO) Chart observations Chart behavior Chart interventions and Pt response